先導性荷爾蒙治療後施行達文西機械手臂輔助攝護腺根除手術用於中度及高度風險攝護腺癌之臨床經驗
胡如、歐宴泉
臺中榮民總醫院外科部泌尿外科
Neoadjvant hormone therapy for localized prostate cancer:  initial experiences in intermittent-and high-risk patients in the robotic surgery era
Ju-Chuan Hu、 Yen-Chuan Ou
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital
 
Purpose: Current guidelines suggest that patients with intermediate- or high-risk prostate cancer (CaP) could be offered neoadjuvant hormone therapy (NHT) before they receive definitive radiation therapy. However, no powerful evidences showed NHT has prognostic benefits to patients receiving robotic-assisted laparoscopic radical prostatectomy (RaLRP) yet. This study was to compare the results of RaLRP in patients who did and did not receive NHT, especially focus on intermediate- and high-risk patients.
Materials and Methods: Patients received NHT prior to RaLRP by a single surgeon were identified from the VGHTC Prostate Cancer Database. Control group was picked out via computerized 1:1 ratio matching with the following criteria: (1) prostate specific antigen (PSA) level at diagnosis (2) initial Gleason score (3) clinical stage (4) Age. NHT regimens include combination of Luteinising hormone-releasing hormone (LHRH) agonist with anti-androgens and individual use of either LHRH agonist or anti-androgens. General characters of patients, peri-operative parameters, functional and oncologic outcome were prospectively recorded.
Results: Total 48 patients with D’Amico intermediate- and high-risk CaP were analyzed. The mean patient age, BMI, preoperative PSA, and Gleason score at biopsy appears equivalent but there’re significant statistic higher percentage of cT2c in control group and a trend of higher percentage of cT3b in NHT group. Shorter operative time (153.5 minutes v.s. 113.3 minutes, p=0.0002) and lesser amount of blood loss (147.08ml v.s. 93.75ml, p=0.131) were found in NHT group. The average period of biochemical recurrence (BCR) was similar (5.33 months v.s. 6.54 months, p=0.523) but the overall BCR rate was significantly lower in NHT group (87.5% v.s. 54.2%, p=0.026). In sub-group analysis, BCR rate was significant lower in NHT group if preoperative PSA level were between 10 to 20 ng/ml (66.67% v.s. 0%, p=0.035) and >50 ng/ml (100% v.s. 55.56%, p=0.018) while BCR rate was 81.82% v.s. 80% (p=0.916) in PSA 20-50 ng/ml. However, average follow-up period was significantly insufficient in NHT group (49.46 months v.s. 20.29 months, p<0.001) although BCR usually happened in the  postoperative first year in our study.
Conclusions: Neoadjuvant NHT followed by RaLRP seems to provide some potential benefits in shorter operative time, lesser amount of blood loss, and lower rate of BCR during postoperative two years in patients with intermediate- or high-risk localized CaP.
 
 
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    TUA秘書處
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    台灣泌尿科醫學會
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    討論式海報
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    2016-05-29 13:20:00
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    2016-05-29 13:21:23
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